Exposure to placental insufficiency alters postnatal growth trajectory in extremely low birth weight infants
Exposure to placental insufficiency alters postnatal growth trajectory in extremely low birth weight infants
复制标题
DOI：
10.1017/s2040174419000564
复制
发表时间：
2020-08-01
影响因子：
1.7
通讯作者：
Pandey, Vishal
中科院分区：
文献类型：
--
作者：
Chou, Fu-Sheng;Yeh, Hung-Wen;Pandey, Vishal
极低出生体重儿（ELBW，出生体重< 1000 g）出生后即刻的生长是新生儿医学的重要课题。其目标是确保出生后的充分发育，并尽量减少因发育不良而引起的并发症。过去的努力集中在产后营养以及尽量减少合并症。尚未系统评估产前因素是否在产后生长中发挥作用。在这份报告中，我们对91对母婴进行了回顾性研究。我们前瞻性地收集了产妇和新生儿的人口统计学数据、出生后前7天和肠内营养完全建立后的新生儿营养、合并症数据以及从出生到50周校正胎龄的体重数据。我们开发了一个线性混合效应模型，以检查胎盘功能不全的作用，定义胎儿多普勒研究，在出生后体重评分轨迹随着时间的推移，在ELBW人口。我们依靠赤池信息准则（AIC）和贝叶斯信息准则（BIC）进行模型选择。有趣的是，所选模型包括时间的二次项和胎盘不耐受性与时间的相互作用项。在协变量分析中，AIC和BIC都倾向于将出生后前7天的卡路里摄入量和抗生素的总持续时间作为固定效应，但不包括它们与时间的相互作用项。总的来说，我们第一次证明了胎盘功能不全，产前因素，是一个主要的决定因素，出生后体重轨迹的ELBW人口。前瞻性研究是必要的，以证实我们的发现。
Growth in the immediate postnatal period for extremely low birth weight (ELBW, birth weight < 1000 g) infants is an important topic in neonatal medicine. The goal is to ensure adequate postnatal growth and to minimize complications resulting from suboptimal growth. Past efforts have focused on postnatal nutrition as well as on minimizing comorbidities. It has not been systematically assessed whether antenatal factors play a role in postnatal growth. In this report, we conducted a retrospective study on 91 maternal-neonatal pairs. We prospectively collected maternal and neonatal demographic data, neonatal nutrition in the first 7 days of life and after enteral nutrition is fully established, comorbidity data, as well as weight data from birth to 50 weeks corrected gestational age. We developed a linear mixed-effects model to examine the role of placental insufficiency, as defined by fetal Doppler studies, in postnatal weightz-score trajectory over time in the ELBW population. We relied on Akaike Information Criterion (AIC) and Bayesian Information Criterion (BIC) for model selection. Interestingly, the selected model included a quadratic term of time and a placental insufficiency-by-time interaction term. In a covariate analysis, AIC and BIC both favored a model that included calories intake in the first 7 days of life and the total duration of antibiotics as fixed-effects, but not their interaction terms with time. Overall, we demonstrated for the first time that placental insufficiency, an antenatal factor, is a major determinant of postnatal weight trajectory in the ELBW population. Prospective studies are warranted to confirm our findings.